Search

Introduction: Sexual health and wellbeing are significant aspects of quality of life. However, taking a sexual history is often avoided in medical practice, leaving a void in management and awareness. As the menopause can have a major impact on sexual health, it is imperative that healthcare providers are appropriately trained in sexual health and wellbeing and the aligned disciplines in order to achieve optimal care., Aim: To provide an evidence-based clinical guide for the assessment and management of sexual problems at the menopause and beyond., Materials and Methods: Review of the literature and consensus of expert opinion., Results and Conclusion: The assessment of sexual problems includes history taking, examination and laboratory investigation (if indicated), and occasionally the use of specific validated questionnaires. Management of sexual problems requires a multidimensional approach using biopsychosocial measures. Medical management and psychosexual counselling include pharmacological and non-pharmacological interventions, and sex therapy and psychoeducation. Furthermore, perimenopausal women should be advised about the need for contraception if they wish to avoid pregnancy. Also, sexually transmitted diseases can be acquired at any age. To conclude, taking a sexual history should be incorporated into medical practice and healthcare providers should be appropriately trained to assess and manage sexual problems at the menopause and beyond., Competing Interests: Declaration of competing interest Stavroula A. Paschou: none declared. Kleoniki I. Athanasiadou: none declared. Trish Hafford-Letchfield: none declared. Sharron Hinchliff: none declared. Melissa Mauskar: Medical Advisory Board: Nuvig; Grant/research support: Incyte. Margaret Rees: none declared. James A. Simon: Grant/research support: AbbVie, Inc., Bayer Healthcare LLC., Dare´ Bioscience; Ipsen, Mylan/Viatris Inc., Myovant Sciences, Sebela Pharmaceuticals Inc.; Consultant/advisory boards: Bayer HealthCare Pharmaceuticals Inc., Besins Healthcare, California Institute of Integral Studies (CIIS), Dare´ Bioscience, Femasys Inc., Khyria, Madorra Pty Ltd., Mayne Pharma, Inc., Vella Bioscience Inc.; Speaker's bureaus: Astellas Pharma, Inc., Mayne Pharma, Inc., Myovant Sciences, Inc., Pfizer Inc., Pharmavite LLC., Scynexis Inc.; Stockholder (direct purchase): Sermonix Pharmaceuticals. Eleni Armeni: none declared. C. Tamer Erel: none declared. Ivan Fistonić: none declared. Timothy Hillard: Remuneration for talks or consultancy work over the last 5 years from: Theramex, Besins, Astellas, Shionogi. Angelica Lindén Hirschberg: consulting fees from Astellas and Gedeon Richter, research support from Besins and Avia Pharma. Blazej Meczekalski: none declared. Nicolás Mendoza: consulting fees from Exeltis, Organon, Theramex and Novonordisk. Alfred Mueck: Grant/research support: Besins/Dr.Kade Company; Consultancies and/or Lectures: Abbott, Bayer, Besins/Dr.Kade, Exeltis, Gedeon Richter, Hexal, Novartis, Jenapharm, MSD, Schaper and Brümmer, Serelys. Tommaso Simoncini: consulting fees from Abbot, Astellas, Gedeon Richter, Mitsubishi Tanabe, Sojournix, Estetra, Mithra, Actavis, Medtronic, Shionogi, Applied Medical. Speakers' honoraria from Abbott, Shionogi, Gedeon Richter, Intuitive Surgical, Applied Medical, Theramex. Petra Stute: Grant/research support: Schaer Pharma, EFFIK; Consultancies: Theramex, Astellas; Membership of speakers' bureau: Theramex, Jenapharm, Labatec, Exeltis, Besins Healthcare, Astellas, Gedeon Richter, Hexal, Pierre Fabre, Zeller. Dorenda van Dijken: none declared. Irene Lambrinoudaki: research grant from ITF Hellas., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Introduction: Thyroid diseases are common in women in their late reproductive years; therefore, thyroid disease and menopause may co-exist. Both conditions may present with a wide range of symptoms, leading to diagnostic challenges and delayed diagnosis. Aim To construct the first European Menopause and Andropause Society (EMAS) statement on thyroid diseases and menopause., Materials and Methods: Literature review and consensus of expert opinion (EMAS executive board members/experts on menopause and thyroid disease)., Summary Recommendations: This position paper highlights the diagnostic and therapeutic dilemmas in managing women with thyroid disease during the menopausal transition, aiming to increase healthcare professionals' awareness of thyroid disorders and menopause-related symptoms. Clinical decisions regarding the treatment of both conditions should be made with caution and attention to the specific characteristics of this age group while adopting a personalized patient approach. The latter must include the family history, involvement of the woman in the decision-making, and respect for her preferences, to achieve overall well-being., Competing Interests: Declaration of competing interest, (Copyright © 2024 Elsevier B.V. All rights reserved.)

Introduction: Late-onset hypogonadism is the clinical entity characterised by low testosterone concentrations associated with clinical symptoms in the absence of organic disease in ageing men. It has been associated with metabolic syndrome, reduced bone mineral density, and increased cardiovascular morbidity and mortality risk. Although testosterone replacement therapy (TRT) reverses most of these conditions in young hypogonadal men, the risk/benefit ratio of TRT in older men is debatable., Aim: To update the 2015 EMAS statement on TRT in older men with new research on late-onset hypogonadism and TRT., Materials and Methods: Literature review and consensus of expert opinion., Summary Recommendations: TRT should be offered only to symptomatic older men with confirmed low testosterone concentrations after explaining the uncertainties regarding the long-term safety of this treatment. TRT may be offered to men with severe hypogonadism and erectile dysfunction to improve sexual desire, erectile, and orgasmic function. It should also be considered in hypogonadal men with severe insulin resistance or pre-diabetes mellitus. TRT may also be considered, in combination with proven treatment strategies, for osteoporosis, or for selected patients with persistent mild depressive symptoms and/or low self-perceived quality of life, combined with standard medical care for each condition. TRT is contraindicated in hypogonadal men actively seeking fertility treatment. Due to a lack of data, TRT should not be routinely used in older men to improve exercise capacity/physical function, improve cognitive function, or prevent cognitive decline. TRT must be avoided in older, frail men with known breast cancer or untreated prostate cancer and all men who have had myocardial infarction or stroke within the last four months, and those with severe or decompensated heart failure. The quality of evidence regarding patients with previous prostate cancer or cardiovascular disease is too low to draw definitive conclusions. Any limits on duration of use are arbitrary, and treatment should continue for as long as the man feels the benefits outweigh the risks for him, and decisions must be made on an individual basis. Withdrawal should be considered when hypogonadism is reversed after the resolution of underlying disorder. Short-acting transdermal preparations should be preferred for TRT initiation in older men, but injectable forms may be considered subsequently. Older men on TRT should be monitored at 3, 6, and 12 months after initiation and at least yearly thereafter, or earlier and more frequently if indicated. Evaluation should include assessment of the clinical response, and measurement of total testosterone, haematocrit, and prostate-specific antigen (PSA) concentrations. Bone density and/or quality should also be assessed. Obese and overweight patients should be encouraged to undergo lifestyle modifications, including exercise and weight loss, to increase endogenous testosterone., Competing Interests: Declaration of competing interest, (Copyright © 2023 Elsevier B.V. All rights reserved.)

Women undergo important changes in sex hormones throughout their lifetime that can impact cardiovascular disease risk. Whereas the traditional cardiovascular risk factors dominate in older age, there are several female-specific risk factors and inflammatory risk variables that influence a woman's risk at younger and middle age. Hypertensive pregnancy disorders and gestational diabetes are associated with a higher risk in younger women. Menopause transition has an additional adverse effect to ageing that may demand specific attention to ensure optimal cardiovascular risk profile and quality of life. In this position paper, we provide an update of gynaecological and obstetric conditions that interact with cardiovascular risk in women. Practice points for clinical use are given according to the latest standards from various related disciplines (Figure 1)., (© The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Introduction: Recent studies have shown that CADM1/MAL-methylation testing detects high-grade CIN lesions with a high short-term progression risk for cervical cancer. Women treated for CIN2/3 are at risk of post-treatment disease, representing either persistent (incompletely treated) or incident (early onset) lesions. Here, we evaluated CADM1/MAL-methylation analysis as potential tool for detecting recurrent high-grade CIN lesions (rCIN2/3)., Methods and Materials: A multicenter prospective clinical cohort study was conducted among 364 women treated for CIN2/3. Cervical scrapes were taken prior to treatment, and six and 12months post-treatment and tested for cytology, hrHPV (plus genotype) and CADM1/MAL-methylation. When at six months either of these tests was positive, a colposcopy-directed biopsy was obtained. At 12months, all women underwent an exit-colposcopy with biopsy. In case of rCIN2/3, re-treatment was done., Results: We found 28 rCIN2 (7.7%) and 14 rCIN3 (3.8%), resulting in a total recurrence rate of 11.5%. All 14 women with rCIN3 and 15/28 (54%) with rCIN2 showed hrHPV type-persistence. Of these, 9/14 (64%) rCIN3 and 8/15 (53%) rCIN2 were CADM1/MAL-methylation positive. All incident rCIN2, characterized by hrHPV genotype-switch, were CADM1/MAL-methylation negative. All three carcinomas found after re-treatment were CADM1/MAL-methylation positive. CADM1/MAL-methylation positivity at both baseline and follow-up significantly increased the risk of ≥rCIN3 (from 0.7% to 18.4%), and ≥rCIN2 (from 8.2% to 36.8%), compared to a consistently CADM1/MAL-methylation negative result (p-value: <0.001)., Conclusion: Post-treatment monitoring by CADM1/MAL-methylation analysis identifies women with an increased risk of rCIN2/3. Our results confirm previous data indicating that CADM1/MAL-methylation analysis provides a high reassurance against cancer., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: Chronic pelvic pain (CPP) is a common clinical condition with significant impact on quality of life. The etiology and pathogenesis of CPP is poorly understood., Materials and Methods: To examine the epidemiology, base line demographics, and clinical variables, women with CPP were prospectively analysed by an integrated and synchronised approach., Results: Of the 89 women with CPP analysed, the majority were assessed earlier, had a variety of surgical interventions and used pharmacological agents. Irritable bowel syndrome, dysfunction of the pelvic floor musculoskeletal system, and physical or sexual abuse were the most common diagnosed etiologies. Evaluation revealed an increased level of psychological impairment., Discussion: CPP is a debilitating clinical condition and a result of complex interaction between different contributing factors. Patients will benefit from an orchestrated, multidisciplinary, and synchronized approach with attention paid to the different domains of pain. Treatment is mostly not curative; avoiding profound suffering despite persisting pain should be the goal.